The Gambling Story Lewis Mehl-Madrona, MD, PhDevergreencpg.org/media/Four_Directions/Mehl...•...

The Gambling Story Lewis Mehl-Madrona, MD, PhD

Coyote Institute for Studies of Change and Transformation and

The Union Institute & University P.O. Box 578, Brattleboro, Vermont 05302

mehlmadrona@gmail.com www.mehl-madrona.com

Tel: 808-772-1099 Fax: 1-802-419-3720

• Download the handout: www.mehl-madrona.com

• Click on the page for “Handouts”.

Visit my blog at http://www.futurehealth.org! Join our Coyote Wisdom online discussion group.

Gratitude

• Grateful to the Swinomish • Grateful to Evergreen

• Grateful to community, to our world, the interconnectedness of everything, to the ecology of our

lives, to the natural order. • Grateful to the 7 directions and the holistic psychology

they offer. • Grateful to my wife and colleague Barbara, for her help

with these slides.

We had a way

• Woc’ekiya – Praying: communicating directly with creator • Wa o’ hola – Respect: for self, higher power, family,

community and all life. • Wa on’sila – Caring and Compassion • Wowijke – Honesty and Truth • Wawokiye – Generosity • Wah’wala – Humility • Woksape – Wisdom.

“Addictions always originate in pain, whether felt openly or in the unconscious. They are emotional anesthetics…. Infant animals separated from their mothers can be soothed readily by low doses of narcotics.”

Gabor Maté (2010). In the Realm of the Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books. .

“[The realm of the hungry ghost] is the domain of addiction where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment.”

Gabor Maté (2010). In the Realm of the Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books.

Arousal

• Amphetamines • Cocaine • Ecstasy • Alcohol • Gambling • Sexual acting out • Spending • Stealing

Arousal

• Sensations of intense raw unchecked power and gives feelings of being untouchable and all-powerful

Satiation

• Feeling full and complete, beyond pain. • Numbing • Heroin, alcohol, marijuana, valium, narcotics,

overeating, watching tv • Addictive rituals • Trance

Addiction

• “Addiction is an illness in which people believe in and seek spiritual connection through objects and behaviours that can only produce temporary sensations. These repeated, vain attempts to connect with the Divine produce hopelessness, fear and grieving that further alienate the addict from spirituality and humanity.”

• Nakken, C. (1996) The addictive personality: Understanding the addictive process and compulsive behavior. Center City, Minnesota: Hazelden

Addiction

• “Addiction is an emotional relationship to an object or event through which addicts try to meet their needs for intimacy.”

• Nakken, C. (1996) The addictive personality: Understanding the addictive process and compulsive behavior. Center City, Minnesota: Hazelden

Abdullah Ibn Senna, Persian Narrative Therapist

• Drug abuse has been defined as a chronically relapsing disorder, in which the addict experiences uncontrollable compulsion to take drugs, while the repertoire of behaviors not related to drug seeking, taking, and recovery, declines dramatically (White, 2002).

• Gambling looks like such an uncontrollable compulsion.

This is where my grandfather and I went fishing. Where did you go fishing?

Two different and opposite molecular pathways activated by drugs have been discovered (Nestler, 2004), which are being related to the motivational power of drugs: • Compensatory adaptations responsible for a

decreased ML-DA functioning induce motivational impairments and loss of interest in activities not associated with drug consumption (Koob & LeMoal, 1997; 2001; Nestler, 2001b, Volkow, 2002; Barrot et al., 2002; Aston-Jones & Harris, 2004).

• Changes responsible for a sensitized DA responsiveness to drug and drug-related stimuli (Vanderschuren & Kalivas, 1999; Nestler, 2002; 2004) may lead drug-related memories to acquire an increasing motivational value (Robinson & Berridge, 2000).

• Reduced activity of the opioid, GABA/benzodiazepine, serat-onin, and dopamine systems increased activity of the sympathico-adrenal system.

• Means: reduced activity in these brain regions is correlated with activation of the cortisol-producing system.

This reduced activity is related to conditions ranging from prenatal stress to trauma, adverse conditions, starvation…

Huizink, AC, et al. (2004). Prenatal Stress and Risk for Psychopathology: Specific Effects or Induction of General Susceptibility? Psychological Bulletin 2004, Vol. 130, No. 1, 115–142

Panksepp and colleagues (1978, 1980) envisioned that the natural negative emotional processes that sustain addictions are related psychologically to the separation-distress process that young animals exhibit when isolated from their caretakers.

Jaak Panskepp

The people emerged into a misty valley, the fog so thick that they couldn’t see anything but pillars of fires in the four directions

In other words: endogenous opioids mediate the rewards of social reunion, which is a powerful evolutionary force for creating social bonds, and, hence addictive tendencies.

3 Cherokee Narrative Therapists who visited England in 1730.

• Permanent functional changes in the ML system and in BG-thalamocortical circuits, arising from repetitive DA stimulation, are involved in the development of compulsive behaviors.

• Means: repeated stimulation of the seeking system, possibly, we can imagine, where the actual reward is frustratingly inconsistent, contributes to compulsive behavior.

(Berke et al., 1998; Robinson & Kolb, 1999; Nestler, 2001a, 2004; Hyman & Malenka, 2001; Koob & LeMoal, 2001; Li et al., 2003; Kalivas et al., 2003).

Activity of the ML-DA system represents a key aspect of the chain of events that leads from a molecular action of drugs to the establishment of compulsive habits.

The people had to make a decision, so they chose the red fire of the North which warmed the people and enabled the plants to grow, teaching the people to respect all the elements of nature.

As a “hedonic homeostatic dysregulation”, drug abuse has a cyclic and progressive nature and is characterized by a pathological alteration of the reward state. As a result of ML-DA hypofunctionality, the deficit in reward functioning throws organisms into a “spiraling distress cycle” and drugs become necessary to restore the normal homeostatic state (Koob & LeMoal, 2001).

Should the people fail in their respect for nature and neglect the ceremonials, the people would disappear from the land and it would fall beneath the water of the ocean.

The affective-homeostatic perspective fails to explain why “after prolonged drug-free periods, well after the last withdrawal symptom has receded, the risk of relapse, often precipitated by drug associated cues, remains very high” (Hyman, 2005 p1414). Moreover, in animal models, re-exposure to drugs or drug-related stimuli reinstates drug-seeking behaviors more strongly than withdrawal (Stewart & Wise, 1992).

This is where I grew up.

The process of sensitization is now considered a key step in the addiction development cycle where repetitive drug intake further enhances the desire to consume drug and further lead to uncontrollable urges. It has been shown that previous drug use, especially that of psychostimulants, increases locomotion, stereotypic responses (“behavioral sensitization”), or the ML-DA response (“biochemical sensitization”) to a subsequent acute dose of the same drug (Vandeschuren & Kalivas, 2000; Sax & Strakowsky, 2001; Ungless et al., 2001). And this happens not just for drug rewards, but a variety of natural rewards (Nocjar & Panksepp, 2002), especially social ones (Nocjar & Panksepp, 2007).

Alice in Wonderland and the Magic Potion:

Eddie lives with his granny. She knows all about magic and Eddie learns from her. One day, he secretly drinks some magic lemonade potion. When Eddie is at school, he finds that he can’t stop laughing..

Deirdra Morris is a well known writer and an actress with the Royal Shakespeare Company, who has written an original story about magic

Eddie and the Magic Potion

He laughs more and more. Then he also becomes bigger and bigger, like a balloon filling up with air. Magic things happen. He laughs hard, and it begins to hurt, but still he can’t stop, and still funny things happen.

This is a popular second grade reader!

Eddie and the Magic Potion

People turn upside down, the noodles in a shop go round the customers, and a policeman and a lady crossing the road find themselves in each others’ clothes. Finally Eddie’s magical granny stops the magic and they have a party.

Eddie and the Magic Potion

Alice in Wonderland and the Magic Potion:

This is my lake – Lake Cumberland. Do you have a lake or a river?

“Context-dependent sensitization” can be used to explore how drug-associated stimuli acquire their incentive value. It also provides an explanation for the phenomenon of relapse, where drug-associated memories maintain the ability to activate the ML-DA system long after the withdrawal has subsided (Shaham et al., 2003). On the other hand, “context independent sensitization” may reflect the increasing ability of drugs to activate the ML-DA system, without contributions from external stimuli (Patridge & Schenk, 1999).

Typical Cherokee village from Cherokee Nation Museum, Cherokee, North Carolina.

The appetitive motivational component stimulated by drugs is an ancestral emotional urge (the SEEKING disposition) regulated by DA transmission and characterized by specific neurodynamic patterns along ventral striatum and ventral BG-thalamocortical circuits. Moreover, this emotion is characterized by neural, behavioral and affective components linked together in complex and synchronized ways.

Panksepp proposes the Affective Neuroetho-logical Perspective of Addiction

Cherokee method of fishing using a stick

According to this perspective, drugs of abuse, especially psychostimulants, provide an artificial way to stimulate the emergence of the SEEKING disposition, through which motivated behavior are normally expressed and certain positive affective feelings, such as the euphoria and exhilaration of exploration and reward pursuit, arise.

The “Trail of Tears and Death” from Tennessee to Oklahoma

The role of the SEEKING disposition in mediating drug-reward is indicated by the similarity between the unconditioned effects of drugs and those of novelty. Novelty may be considered the unconditioned stimulus to which the SEEKING system is naturally predisposed to react (explaining why novelty promotes exploration), while drugs activate the same system in a pharmacological way.

The Seeking System Explanation

John Ross, Chief of the Cherokee Nation during the Trail of Tears

Novel environments enhance the rewarding and psychomotor activating properties of drugs, leading to environment specific sensitization (Badiani et al., 1995; 1998;Badiani & Robinson,2004). The disposition to seek and explore, already active in the presence of novelty, is further activated by drugs, creating an amplified effect.

Green Corn Ceremony

Commonalities between novelty and drug reward explain why addiction is so pervasive and difficult to stop. If natural rewards activate the ML-DA system in unpredictable and novel situations, a DA-induced activation of the SEEKING urge will help the animal to both achieve its goal and to learn from its current experiences.

As environments become increasingly familiar, the SEEKING disposition is not activated as intensely. However, drugs of abuse will continue to activate the ML-DA system pharmacologically even in familiar situations, bringing about the experience of novelty and of its associated euphoric effects.

Cherokee Home.

This process will cause repetitive and abnormal learning until the motivational and behavioral repertoire of organism becomes thoroughly captivated by drug-related activities.

Cherokee blue grass band in Kentucky taken from the North Carolina collection of Cherokee Cultural Archives.

Strong associative memories between the SEEKING disposition and drug-related stimuli create the neural conditions for drugs to progressively increase their incentive value. In this view, drug-related memories push organisms to consume drugs primarily by activating the SEEKING emotional disposition (at least at the first stages of the addiction process).

This is where my father came from. He and my mother met while he was in the U.S. Air Force, stationed in Kentucky. They met at a USO dance.

The involvement of the SEEKING disposition in the first stages of addiction is consistent with evidence that sensitization arising from repeated drug injections not only promotes the establishment of drug-seeking behaviors, but also increase the vigor of normal motivational, non drug-related activities, such as a pursuit of sexual and food rewards in rats (Nocjar & Panksepp, 2002, 2006; Panksepp et al., 2004).

This is the church in the town where my father grew up.

The SEEKING neurodynamics are the affective-action centered functional structures, whereby drug-related memories and drug-seeking behaviors become linked together.

Sunflowers in the prairies around Wounded Knee.

The abnormal and continuous activation of the SEEKING disposition by drugs is also responsible for the consolidation of compulsive habits, when behavioral routines to find and consume drugs become part of epigenetic changes in the SEEKING dispositions (Ikemoto & Panksepp, 1999).

See the story of Jumping Mouse in Coyote Medicine for more buffalo news!

The SEEKING neurodynamics activated in ventral BG by drug-associated memories are progressively transformed into behavioral sequences associated with compulsive habits and expressed habitually in dorsal BG circuitry. In such cases, addicts may no longer seek drugs just because of subjectively experienced elevated desire and euphoria but because of the power of automatically expressed habitual stereotypical compulsive behaviors (that are also well suited to effectively alleviate withdrawal distress).

See the story of Jumping Mouse in Coyote Medicine for more buffalo news!

The SEEKING neurodynamics activated in ventral BG by drug-associated memories are progressively transformed into behavioral sequences associated with compulsive habits and expressed habitually in dorsal BG circuitry. In such cases, addicts may no longer seek drugs just because of subjectively experienced elevated desire and euphoria but because of the power of automatically expressed habitual stereotypical compulsive behaviors (that are also well suited to effectively alleviate withdrawal distress).

Vulnerable individuals, after drug experiences, show fewer or less functional D2 autoreceptors (White & Wang, 1984;Cabib et al., 2002;Volkow et al., 2002;Nader & Czoty, 2005). Maternally separated rats, which are more vulnerable to addiction, exhibit lower levels of DAT in adulthood compared with controls with direct implications for greater responsiveness to drugs and stress (Meaney et al., 2002).

Sunset in South Dakota.

Socially dominant monkeys present higher levels of D2 receptors, protecting them against the rewarding effects of cocaine (Morgan et al., 2002). Lower expression or functionality of self-inhibitory processes in the ML system may compensate for the endogenous hypofunctionality of ML-DA transmission. Although basal levels of DA are restored, the ML-DA system will became less capable of self-regulating its own activity.

Wounded Knee, South Dakota.

In situations where unusual stimuli, such as drugs of abuse or novel environments, induce a consistent release of Dopamine into the Nucleus Accumbens and related basal forebrain regions, the deficiencies in the inhibitory mechanisms in the Mesolmbic system will cause abnormally elevated Dopamine responses. Therefore, vulnerable individuals may experience greater rewarding effects of drugs, partly due to a higher activation of the SEEKING emotional disposition.

The Mesolimbic Dopamine System:

Jingle Dance at the Oglala Pow Wow on Pine Ridge Reservation 2006.

In the affective neuroethological perspective, the ML-DA is part of a general purpose appetitive foraging system (the SEEKING system) that allows animals to become acquainted with the diverse configurations and reward of their environments, and thereby establish realistic and adaptive expectations. This system, perhaps some subcomponents more than others, also participates in protecting animals against the vicissitudes of their world (punishing contingencies) by promoting the seeking of safety.

Buffalo grazing in the prairies around Wounded Knee

In its primal form the ML-DA-SEEKING system can generate a special kind of positive affect that is characterized by a euphoric engagement with the world. To the extent that the normal range of arousal of this system can be defined, it routinely tends to promote an affectively positive engagement with the world, even though it may not be able to completely counteract a negative affective state that has been concurrently aroused by various punishing events that require the seeking of safety.

So what does this mean? The Prairie around Wounded Knee.

The Wounded Knee Memorial

Stories, myths are examples of seeking

Indigenous wisdom

Dr. Charles Alexander Eastman (Sioux: Ohiyesa, (pronounced Oh hee' yay suh), February 19, 1858 - January 8, 1939) was a Native American author, physician and reformer. He was active in politics and helped found the Boy Scouts of America.

By the way, narrative has indigenous roots

Adam Beach portraying Dr. Charles Eastman in the HBO movie, Bury My Heart a t Wounded Knee.

“Narrative is present in every age, in every place, in every society; it begins with the very history of mankind and nowhere has there been a people without narrative. All classes, all human groups, have their narratives, enjoyment of which is very often shared by men with different, even opposing, cultural backgrounds.” (Barthes)

Bernstein Bears

Stories are used extensively for human communication; both the comprehension and production of oral and written narratives constitute a fundamental part of our experience.

Raymond Mar

We make meaning by making stories…

Jerome Bruner, PhD and M. Turner, PhD

“Narrative organizes not just memory, but the whole of human experience—not just the life stories of the past, but all of one’s life as it unfolds.” “Narrative constructs our notion of reality; the experience of life takes on meaning when we interact with it as an ongoing story.”

AI Scientist Roger Schank: • To be without stories

means to be without memories, which means something like being without a self.

Kay Young, Ph.D. and Jeffrey L. Saver, M.D.

The storytelling we experience as an event in life can lose its appearance as narrative by virtue of its integration in life. We are so used to having conversations that function as stories that we pay little attention to their nature.

“Through the hearing and telling of stories, children learn what a child and what a parent is, who populates the world around them and what the ways of the world are.”

MacIntyre, Vygotsky, Trevarthan:

What is Story? • A hero (we are all heroes in our

own story) • A goal (global domination, relief

from pain) • Helpers (angels, friends) • Obstacles (dragons, poverty,

lack of support, evil potions) • Attitude (optimistic,

melancholic) • Outcome

What is Narrative? • Action from a beginning to an end. • Embodied in location and in

characters. • Conveying a meaning or message

(what is the point of the story?). • Conveys values and emotion. • Plausible and engaging to an

audience for a purpose.

An addiction is a journey story. • When we make plans, we plan

journeys.. • With addiction, our planning

might have some flaws at the self-world interface.

• Stories are co-created by the audience.

• Communities of addicts have powerful stories.

Telling a Story • Narratives tell stories through a

sequence of actions or events • They may be very simple or

complex • Structuralist analyses have

suggested that many narratives involved a relatively limited number of key characters (or character functions) the hero or the villain for example.

Trevarthan (2001):

“Body-mapping mechanisms emerge in the embryo CNS, before peripheral sensory and motor nerves connect the brain to the body receptors and muscles, and core brain systems exercize a primary influence over the formation of the cerebral cortex in the fetus.”

Trevarthan (2001):

“Intercellular communication regulated by gene expression forms systems in the fetal brain that will 'mirror' other persons' actions in the infant.”

Trevarthan (2001):

Aminergic neural regulators of internal physiological state and of brain morphogenesis in utero are identical with the Intrinsic Motive Formation and Emotional Motor System that shape and pace both expressions of communication and the experience- dependent elaboration of cognitive systems post-natally.

Trevarthan (2001):

A neural mechanism adapted for cognitive assimilation of socio-emotional information 'brain-to-brain', and for transmitting knowledge and skills in a cultural context, is laid down prenatally.

Trevarthan (2001):

“Communicating infants actively adapt to human movements in regulated rhythmic patterns, sympathetically mirroring expressions that indicate motives of intersubjective relating.

Trevarthan (2001):

“The motives for intersubjective relating to a parent's intuitive sympathetic communications are powerful anticipatory forces in mental growth.”

Trevarthan (2001):

“A subject's purposes and attentions for finding and choosing experience outside the body can be communicated only by mirroring of the control of somatic muscles that move the body and focus receptors on goal objects..”

Trevarthan (2001):

The combined operation of visceral and somatic mirror reactions gives the infant access to the other subject's anticipatory 'motor images', and permits direct motive-to-motive engagement with a companion, and interest in a shared environment.

Trevarthan (2001):

A psychobiology of childhood that takes account of the development in communication of the emotionally-motivated child, with attention to the whole human brain, contrasts with present theory of developmental cognitive neuroscience that continues to be individualistic, rational and cortico-centric.

Roger Schank, PhD

“We need to tell someone else a story that describes our experience because the process of creating the story also creates the memory structure that will contain the gist of the story for the rest of our lives”.

Roger Schank, PhD

“While we will not hold onto the words of the telling, our retention of the story’s core will make a cognitive space or an environment for thought that can be drawn upon when the gist of the story serves a new purpose.”

Stories:

• Give cognitive and emotional significance to experience • Provide a means of constructing and negotiating a social identity, • give moral weight and existential significance to actions and events.

Stories direct our attention:

The human brain is limited in its ability to process information, and simultaneous processing cannot occur without a substantial cost. Shifting of attention is necessary because it allows us to redirect attention to aspects of the environment we want to focus on, and subsequently process.

Stories direct our attention:

When an object or area is attended, processing operates more efficiently. We are limited by the size of our visual field. With multiple objects in a scene, only some may show up in our field of vision at one time. The eyes, along with one’s attention must constantly be moved and, in a sense, refocused.

Change comes from combinations of empathy, affect regulation, construction of narrative, and behavioral experiments, resulting in the development and healthy integration of multiple neural networks.

The Neuroscience of Psychotherapy: Healing the Social Brain, Second Edition Louis Cozolino, PhD, 2010

Both indigenous and post-modern thought:

Truth is not ‘out there’ waiting to be discovered and measured, leading to rules and regularities, but is constructed by people interacting with their environment, always provisional and contingent on context and relationship.

Pasupathi, 2001:

Emphasizes a process in which we attribute meanings to events and create a story to contain and explain our experience. Our knowledge of ‘reality’ is a story we tell ourselves.

Pasupathi, 2001:

Two principles govern our personal story: 1) Co-construction (the joint influence of speakers and contexts on conversational reconstructions of personal events. 2) Consistency (the influence of a conversational recounting on subsequent memory.

Lakoff and Johnson (1980):

‘Metaphor is one of our most important tools for trying to comprehend partially what cannot be comprehended totally: our feelings, aesthetic experiences, moral practices, and spiritual awareness' (p. 193). In their view 'metaphorical imagination is is a crucial skill in creating rapport and in communicating the nature of unshared experience‘ (p. 232).

Lakoff (1993):

We use our basic bodily understanding of places, movement, forces, paths, objects, and containers as sources of information about life and about abstract concepts.

Every symptom tells a story: • Psychopathology may be the product of what

remains healthy in a person seeking to make

sense of, and give expression to, what has gone wrong.

• Symptoms can be seen as the efforts of a healthy self to find words and meanings that adequately express an individual's struggle with altered experiences.

Hunter, 1991: • A narrative stance attributes significance to

each account, without seeking to reduce one to the other (explanatory pluralism).

• “The subjective, personal, patient story and

the interpretative, scientific, medical story are not translations of each other but independently co-existing narratives".

Indigenous narrativity: • Every symptom has a spirit within in or

standing behind it, breathing onto it like a wind to fuel its fire.

• To understand an illness or a symptom, we must hear its story.

• To heal an illness, we must negotiate with the teller of its story.

• Simplistically this has been translated as the “evil spirit” metaphor.

Visualizing movement

In this functional magnetic resonance imaging (fMRI) study, areas that responded to real motion but not while motion was being imagined are shown in red, and areas that were active during motion imagery but not to real motion are shown in green. Areas that were active in both conditions appear as orange & yellow (Thompson & Kosslyn, 2000). Note that the areas unique to imaginary movement are in the frontal cortex and temporal cortex in the brain’s story production and comprehension areas.

Reported peak activations for studies of narrative comprehension, narrative production, selection and ordering:

Abbreviations: (CE19) Temporal, (CE18) Fronto–temporo-parietal, (CE09) Subcortical-fronto-temporal, (CE04) Cerebellooccipital; (HE17) Temporal; (HE14) Fronto-parietal; (HE11) Fronto-temporal; (HE06) Limbic: parahippocampal–amygdalar; (HE02) Occipito-cerebellar. (NHE19) Temporal, (NHE18) Frontal, (NHE13) Subcortical–temporal–frontal, (NHE12) Parieto-frontal.

Brodmann’s Areas

Potential Brain Areas Predicted by Cognitive Models:

Broadman’s Areas

Roberts, 1999; Mehl-Madrona, 2010: • The action of creating narrative, by attaching words

to experiences so that they can be made sense of, forms part of the wider action of responding appropriately to a situation – narratization is necessary for life.

• The psychotherapy for addiction consists of helping people to deconstruct their non-working narratives or to construct narratives of meaning that permit them to live in the world with less suffering.

Strings by San Meredith, Convergence Gallery, Santa Fe, NM

Jaspers, 1974:

A narrative view values content, and in seeking to understand a person’s story, one is engaged in re-contextualizing the illness in the life experience of the individual.

Roberts, 1999; Mehl-Madrona, 2010: This in turn may inform recovery and give insight into

its complexities, which may include the loss of the compensations of delusional beliefs and re-engagement with the implications of having an addiction and what preceded it.

Recovery may involve an initially painful loss of meaning and uniqueness that gives rise to a benefit of greater connectedness and wholeness but not without a painful bridge from isolated but meaningful uniqueness and superiority to connected, nurturing, but ordinary relationships with others.

WELLBRIETY

The Roots of Suffering

Wellbriety

• “It takes an entire village to raise a child. It takes an entire village to destroy a child.”

• Don Coyhis. The Red Road to Wellbriety: A cultural approach to healing.

Wellbriety

• Connect with nature • Honor teachings • Create community • Balance in the medicine wheel

A Healing Forest…

Satiation

• /tmp/PreviewPasteboardItems/Don Coyhis Presentation1 - The Red Road to Wellbriety (dragged).pdf

The Medicine Wheel

The Medicine Wheel and the 12 Steps

“Warrior Down”

• “Addiction is an emotional relationship to an object or event through which addicts try to meet their needs for intimacy.”

• Nakken, C. (1996) The addictive personality: Understanding the addictive process and compulsive behavior. Center City, Minnesota: Hazelden

Community of Recovery

We have ceremony • Return to community • Understand the suffering and the web of stories that

create and support it • Listen without judgment: suffering is a badge. Scars are

our medals. Illness is a teacher. • Recreate the vision of the heroic journey – those who

have gone to the underworld come back with lessons in life and in compassion.

• Negotiate a better life with the spirit of the illness • Ceremony to honor the individual and the suffering

and to say farewell to the wounds.

Modern Day Sweat Lodge

A 19th Century Lakota Sweat

The Big Picture of a Cree (Alberta) Sweat Lodge (19th Century)

Men Cooling Off after Sweat (19th Century)

Bear Butte, Lakota Sacred Mountain “Visions, a world beyond the frog-skin world..."

-- Archie Lame Deer

The Sun Dance Tree of Life

Lakota Drawing of the Sun Dance

Today’s Arbour

Resources:

• My web site: http://www.mehl-madrona.com • Open discussion group:

http://groups.google.com/group/coyotewisdom • Aboriginal Mind and Mental Health discussion

group and resource page: • http://groups.google.com/group/aboriginalmind.

Resources: • Integrative Psychiatry On-Line textbook:

http://groups.google.com/group/integrativepsychiatry.

• On-line forum and resources for traditional culturalhealing: http://groups.google.com/group/culturalandtraditionalhealthandhealing.

• Evolving website: www.coyoteinstitute.us (Coyote Institute (for Studies of Change and Transformation).

Lewis Mehl-Madrona, MD, PhD

Coyote Institute for Studies of Change and Transformation

P.O. Box 578, Brattleboro, Vermont 05302 mehlmadrona@gmail.com www.mehl-madrona.com

808-772-1099 Fax: 802-419-3720